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Gynaecologic Oncology

Gynae Oncology is defined as a specialised field of medicine that focuses on diagnosing and treating cancers related to the female reproductive system, including ovarian cancer, uterine cancer, vaginal cancer, cervical cancer and vulvar cancer.

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Overview

A woman’s body goes through a plethora of changes in a lifetime. While puberty is the first step, hormonal changes, physical growth, functioning of the reproductive organs, conception, childbirth, menopause, and the list goes endless. Unfortunately, women’s health is still an underplayed and ignored topic in our society and doesn’t hold great significance even among the most educated families.

One of the health conditions that can wreck a woman’s life and her loved ones is cancer, and it can happen to anyone, at any age. It is imperative for women to take care of their health as they age, get tested regularly and be aware of changes in the body. Gynaecological cancers amount to the majority of deaths among women in our country and worldwide.

Types

1. Cervical Cancer: Cervical cancer is one of the prevalent gynaecological cancers in India. Cervical cancer happens when the cells present in the cervical lining starts dividing abnormally. Chronic HPV infection is the biggest risk factor for cervical cancers.

2. Ovarian Cancer: Ovarian cancer occurs when the cells present in the ovaries start dividing uncontrollably and form a cancerous mass. Ovarian cancer is often detected in advanced stages.

3. Uterine Cancer or Endometrial Cancer: Endometrial cancer refers to the formation of cancerous mass in the lining of the endometrium. It is one of the rare cancers in India.

4. Vaginal Cancer: Vaginal cancer happens when the cells present in the vaginal lining start dividing abnormally. Smoking, chronic HPV infection, having multiple sexual partners, etc., are some of the risk factors for vaginal cancers.

5. Vulvar Cancer: Vulvar cancer is one of the rare gynaecological cancers, wherein the cells present in the vulva (outer part of the female genitals) start dividing abnormally.

6. Fallopian Tube Cancer: Fallopian tube cancer is a rare gynaecological cancer. It occurs when the cells present in the fallopian tube start multiplying uncontrollably and form an abnormal mass.

Diagnosis and Treatment

Gynaecologic Oncology, which is also known as gynaec oncology or gynae oncology, is a specialised field of medicine that focuses on diagnosing and treating cancers related to the female reproductive system. Doctors trained in this area are experts with a detailed understanding of the female reproductive system, cancer affecting these organs, diagnosis and treatment procedures.

Diagnosis of Gynaecological Cancers

There are multiple testing methods available for the detection and diagnosis of gynaecological cancers:

a. Medical History Assessment and Physical Exam: Initially, when a patient presents herself with the symptoms of a particular type of gynaecological cancer, the doctor studies the patient’s medical history to understand the cause of symptoms and to check if the patient has any risk factors that are associated with gynaecological cancers.

Later, the doctor may examine the patient for the signs of gynaecological cancers. The physical exam for gynaecological cancers usually involves a pelvic exam, wherein the doctor checks the pelvic region for the presence of lumps, pain and other symptoms.

b. Lab Tests: Lab tests are recommended to determine the levels of specific tumour markers and other indicators of tumour growth. These tests may also be recommended to assess the functions of critical organs.

c. Pap Test: Pap test is a screening test that is commonly recommended for cervical cancer. During this procedure, the cells from the cervical lining are collected using a small brush; these cells are later examined under a microscope for signs of cancer.

d. Imaging Scans: Imaging tests help doctors in obtaining detailed structures of the organs present in the pelvic region and finding out if there are any tumour growths. Ultrasound scans, MRI scans, PET-CT scans, etc., are some of the commonly recommended imaging tests for gynaecological cancers.

e. Biopsy: Certain gynaecological cancers are diagnosed with the help of a biopsy. During this procedure, a small amount of tissue is collected from the suspected area and examined under a microscope for the presence of cancer cells. Biopsy samples may either be collected via an image-guided needle or during open surgery or by using other specialised instruments.

Treatment of Gynaecological Cancers

While detecting the presence of cancer cells is extremely crucial, precise treatment aimed at faster recovery is equally imperative.

a. Surgery: Open surgery or minimally invasive procedures comprise one of the main modalities of treatment for gynaecological cancers. The onco surgeons remove the cancerous growth and also organs, if needed and curtail further spread of the tumour. Following are the key surgical approaches recommended for gynaecological cancers:

  • Wide local Excision: This procedure involves the removal of the tumour along with a small amount of surrounding healthy tissue.
  • Debulking Surgery or Cytoreductive Surgery: This surgery removes as much of the cancer growth as possible. Debulking is followed by chemotherapy or radiation therapy, wherein the residual cancer cells are destroyed. Debulking may also be recommended as a part of palliative care.
  • Total Hysterectomy: During this procedure, the surgeon removes the uterus along with the cervix.
  • Radical Hysterectomy: This surgical procedure removes the uterus, cervix and a portion of the vagina. In some cases, the ovaries, fallopian tubes and the lymph nodes nearby may also be removed.
  • Salpingo-oophorectomy: This surgery removes the ovaries and fallopian tubes; depending on the severity of the disease, the doctor may either recommend unilateral salpingo-oophorectomy (removal of one ovary and one fallopian tube) or bilateral salpingo-oophorectomy (removal of both ovaries and both fallopian tubes).
  • Omentectomy: This procedure involves the removal of the omentum, which is a thin flap of abdominal tissue that envelops the stomach, large intestine and other digestive organs.
  • Lymph Node Removal: This is a surgical procedure that removes the lymph nodes that may be affected by cancer.

b. Radiation Therapy: During this procedure, high-intensity radiation beams, which could either be X-rays or proton beams, are used to kill cancer cells. Radiation therapy is a non-invasive procedure and is often administered in combination with other treatment methods to enhance the overall efficacy of the treatment given.

Radiation therapy may be administered externally or internally, depending on the type of cancer and its stage.

Radiation therapy may also be recommended to ease pain and other discomforts in patients with advanced-stage gynaecological cancers.

c. Chemotherapy: Chemotherapy is a form of systemic therapy that uses powerful anticancer drugs to destroy cancer cells and stop them from spreading. Chemotherapy may be administered both before the surgery (neoadjuvant chemotherapy) to shrink the tumour and after the surgery (adjuvant chemotherapy) to destroy the cancer cells that may be left behind after the surgery.

Along with these treatment methods, gynaecological cancers may also be treated with hormone therapy, immunotherapy and targeted therapy.

Gynaecologic Oncology at HCG

HCG, a pioneer in cancer care, employs a multidisciplinary approach in treating its patients. Trained at various eminent international hospitals, our team of gynae-oncologists/onco-surgeons, medical oncologists and radiation oncologists believe in a patient-centric approach, backed by empathy and positivity to fight against cancer.

The role of the female reproductive system in a woman’s life is enormous, and we understand it like no other. Though surgery forms the first line of treatment, our experts are always mindful of fertility-preserving options (especially in case of uterine and ovarian cancers) and plastic reconstruction options (vulvar cancers), even while treating the condition deftly.

For any patient, a better quality of life is the ultimate goal post-treatment. And we ensure that, totally.

Services available at HCG’s gynaecologic oncology department include:

  • Staging laparotomy for early ovarian, uterine cancers
  • Cytoreductive surgeries for advanced ovarian and uterine cancers
  • HIPEC treatment/ intraperitoneal chemotherapy. 
  • Radical hysterectomy for cervical cancer.
  • Pelvic and para-aortic lymph node dissection
  • Minimal invasive surgery – laparoscopy and robotic surgeries for feasible gynaecological cancers and benign gynaecological conditions
  • Radical/modified, radical vulvectomy +/- inguinal node dissection with/without plastic reconstruction for vulvar cancer.
  • Hysteroscopy – diagnostic/ therapeutic for endometrial sampling, polyps, D&C.
  • Colposcopy and guided biopsy

Frequently Asked Questions

1. What are the common risk factors for gynaecological cancers?

Most cancers do not have any single identifiable causative factor. But some common triggers behind gynaecological cancers are menopause, family or genetic history of ovarian, breast and uterine cancers, infertility, obesity, chronic vulvar irritation, excessive usage of estrogen hormone, multiple sex partners, early onset of sexual life, and infection with HIV or persistent Human papillomavirus infection.

2. What are the common symptoms of gynaecological cancers?

Abnormal vaginal bleeding, excessive white discharge, pelvic pain, pressure, difficulty in eating, bloating, pain in the abdomen and back, heavier and longer periods are some of the common symptoms of gynaecological cancers.

3. Are gynaecological cancers treatable?

Gynaecological cancers are treatable. Today, we have a multitude of treatment options available.

Unlike before, today, doctors are able to treat even advanced-stage gynaecological cancers.

However, early detection plays a pivotal role in treating cancers successfully and bringing down the risk of a relapse. For cancers to be detected early, it is important for women to be mindful of symptoms that are associated with gynaecological cancers and report them to their physician at the earliest.

4. How are gynaecological cancers diagnosed?

Gynaecological cancers are detected with the help of clinical examination and various tests, including ultrasound, CT-Scans, MRI, PET-CT, blood work, Pap smear & biopsy. In certain cases, other tests like colposcopy, hysteroscopy, dilation & curettage (D&C), laparoscopy may be recommended for more detailed information.

5. Are gynaecological cancers hereditary?

A majority of gynaecological cancers are not hereditary. However, in certain families, genetic predispositions, Hereditary Breast and Ovarian Cancer (HBOC), Hereditary Non-Polyposis Colorectal Cancer (HNPCC) or Lynch syndrome can increase the chances of getting certain types of gynaecological cancers.

6. What are the treatment side effects?

The common side effects while undergoing treatment for cancer include anaemia, fatigue, nausea, vomiting, diarrhoea, appetite loss, bleeding, loss of hair, weight and easy bruising especially following chemotherapy and radiation. However, with recent advancements, treatments given today are more tolerable.

If these side effects are severe, patients can talk to their doctor, who can help with medications and other interventions that help in easing the ill effects of the treatment given.

7. How do I reduce the risk of cancer recurrence?

Eating a healthy, wholesome diet, sticking to an active lifestyle, staying positive, keeping up with your regular doctor’s appointments and undergoing periodic health checks play a crucial role in prevention, early detection and successful treatment and avoiding cancer recurrence.

8. Are there any ways to reduce the risk of developing gynaecological cancers?

Staying healthy, maintaining a healthy weight, chronic conditions like diabetes, hypertension, obesity under check, being aware of family history of cancer if any, getting annual Pap smear tests and taking a vaccine to avoid certain types of cancers, having safe sexual practices, reducing the risk of developing gynaecological cancers, etc., are some ways you can reduce your risk of developing gynaecological cancers.

9. Will I be able to get pregnant after receiving treatment for gynaecological cancer?

Certain types of cancers affecting the ovaries, the uterus can cause infertility issues. Chances of conception and having a healthy baby depend on various factors including the age of the patient, type of cancer and the treatment. Cancer survivors under the age of 30 stand the best chance of conception after completion of treatment if the fertility-preserving option is feasible.

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